Medicine and Health Sciences Commons^™

Distributing Condoms And "Hope": Race, Sex, And Science In Youth Sexual Health Promotion, Chris A. Barcelos

Doctoral Dissertations

This project uses discursive, visual, and ethnographic approaches situated in a critical feminist methodology to understand how ways of knowing about youth sexuality and reproduction influence community health work. I understand the “problem” in this inquiry as the discursive contexts that limit critical ways of knowing about young people’s sexual subjectivities and practices and about the design of policies and programs. Although race, class, gender, and sexuality are understood in the public health literature as important social determinants of health, there is a lack of research that applies a critical, feminist lens to these constructs. I draw on three years …

Bidirectional Relationships Between Maternal Parenting Behaviors And Conduct Disorder Symptoms In Preschool Children, Benjamin Rolon Arroyo

Doctoral Dissertations

Conduct disorder (CD) symptoms emerge in preschool children, and some evidence for bidirectional effects between maternal parenting behaviors and these symptoms has been found in school-age children and adolescents. However, the strength and pattern of these effects are unknown during the preschool years. The present study examined the bidirectional relationships between several key maternal parenting behaviors (negative affect, warmth, overreactivity, and laxness) and CD symptoms across the preschool years. Participants were 197 preschool children (M = 44.24 months, SD = 3.37; Girls = 92) exhibiting significant behavior problems and their mothers who participated in a 3-year longitudinal study. Maternal …

Acute Pain Symptom Assessment And Management In Nonverbal Puerto Rican Patients In The Early Postoperative Period, Sherily Pereira

Doctoral Dissertations

Acute pain is a symptom that represents significant concern for surgical patients during the early postoperative period. This is probably due to the use of ineffective instruments or protocols for assessment in patients with different levels of sedation after general anesthesia. This study described the relationships between the total scores obtained from two pain assessment instruments, the Non-verbal Pain Scale Revised (NVPS-R) and Critical Care Pain Observation Tool (CPOT), during the early postoperative period for non-verbal patients at Post Anesthesia Care Unit (PACU). After assessing patient’s pain with both instruments simultaneously, we determined, and evaluated the relationships between the two …

The Effect Of Interruptions On Primary Task Performance In Safety-Critical Environments, Cheryl Ann Nicholas

Doctoral Dissertations

Safety critical systems in medicine utilize alarms to signal potentially life threatening situations to professionals and patients. In particular, in the medical field multiple alarms from equipment are activated daily and often simultaneously. There are a number of alarms which require caregivers to take breaks in complex, primary tasks to attend to the interruption task which is signaled by the alarm. The motivation for this research is the knowledge that, in general, interrupting tasks can have a potentially negative impact on performance and outcomes of the primary task. The focus of this research is on the effect of an interrupting …

Multi-Classifier Fusion Strategy For Activity And Intent Recognition Of Torso Movements, Abhijit Kadrolkar

Doctoral Dissertations

As assistive, wearable robotic devices are being developed to physically assist their users, it has become crucial to develop safe, reliable methods to coordinate the device with the intentions and motions of the wearer. This dissertation investigates the recognition of user intent during flexion and extension of the human torso in the sagittal plane to be used for control of an assistive exoskeleton for the human torso. A multi-sensor intent recognition approach is developed that combines information from surface electromyogram (sEMG) signals from the user’s muscles and inertial sensors mounted on the user’s body. Intent recognition is implemented by following …

Gestational Weight Gain And Maternal Health Among Hispanic Women, Megan W. Harvey

Doctoral Dissertations

More than 70% of women do not gain within their target range of gestational weight gain (GWG), as recommended by the Institute of Medicine (IOM) in 2009. Risks associated with inadequate GWG include small-for-gestational age, low birthweight, pre-term birth, and difficulty establishing breastfeeding. Risks associated with excessive GWG include large-for-gestational-age, macrosomia, and delivery complications. There are also long-term consequences for maternal and fetal metabolic processes. Higher pre-pregnancy BMI, lower education level, and higher parity are known risk factors for excessive GWG. There are also possible racial / ethnic differences, and Hispanic women, in particular, may be at high risk for …

Assessment Of Gambling And Co-Occurring Mental And Behavioral Health Disorders: Implications For Public Health, Nene C. Okunna

Doctoral Dissertations

Gambling is a very popular form of entertainment and socialization in the US and is generally considered a safe form of recreational activity. There is some evidence of associations between positive health outcomes, as well as poor behavioral and mental health conditions with gambling. However, the relationship between recreational gambling and risk health behaviors has been under researched and thus poorly understood. The 2011 Massachusetts Expanded Gaming Act provides the impetus to understand gambling related problems prior to the introduction of new gambling opportunities. The objectives of the study are twofold: (1) examine associations between recreational gambling and, behavioral and …

Design, Implementation, And Evaluation Of A User Training Program For Integrating Health Information Technology Into Clinical Processes, Ze He

Doctoral Dissertations

Health information technology (IT) implementation can be costly, and remains a challenging problem with mixed outcomes on patient safety and quality of care. Systems engineering and IT management experts have advocated the use of sociotechnical models to understand the impact of health IT on user and organizational factors. Sociotechnical models suggest the need for user-centered implementation approaches, such as user training and support, and focus on processes to mitigate the negative impact and facilitate optimal IT use during training. The training design and development should also follow systematic processes guided by instructional development models. It should take into account of …

Mobile Produce Markets: A Strategy For Increasing Access To Fruits And Vegetables Among Low Income Urban Residents, Bi-Sek J. Hsiao

Masters Theses

Mobile produce markets (MPM) are a community-based strategy to improve produce access in areas with few fruits and vegetables (FV) retail options. The purpose of this thesis is to assess the functionality of MPM in low-income urban neighborhoods. This thesis includes three studies. Study 1 investigates FV availability in areas around MPM locations (n=13). We found limited fresh FV availability in stores, but high prevalence of 100% juice, and canned FV and beans. Study 2 applied questionnaire data from MPM shoppers (n=143) to assess MPM experiences. Chi Square was used to compare shopping behaviors between older (≥ 60) and younger …

Does Age Influence Dynamic Stability And Muscular Power Following Neuromuscular Fatigue In Women?, Ben J. Hoffmann

Masters Theses

Older adults, especially older women, produce less muscular power than young adults, due primarily to slower maximal contractile velocity. These decrements may lead to increased fall risk in older women and can be exacerbated by fatigue. Recently, a 32 min walking task (32MWT) was shown to elicit fatigue in older women. The purpose of this study was to determine whether knee extensor (KE) maximal velocity is related to dynamic stability (margin of stability, MoS) in young and older women pre- and post-32MWT. METHODS: Nine young (Y; 24.3+1.1years, mean±SE) and 17 older (O; 71.1±1.1years) healthy women completed 2 testing sessions on …

A Comparison Of Techniques For Handling Missing Data In Longitudinal Studies, Alexander R. Bogdan

Masters Theses

Missing data are a common problem in virtually all epidemiological research, especially when conducting longitudinal studies. In these settings, clinicians may collect biological samples to analyze changes in biomarkers, which often do not conform to parametric distributions and may be censored due to limits of detection. Using complete data from the BioCycle Study (2005-2007), which followed 259 premenopausal women over two menstrual cycles, we compared four techniques for handling missing biomarker data with non-Normal distributions. We imposed increasing degrees of missing data on two non-Normally distributed biomarkers under conditions of missing completely at random, missing at random, and missing not …

Comparison Of Hip And Wrist Accelerometers In A Pre-Adolescent Population In Free-Living And Semi-Structured Physical Activity, Matthew Ahmadi

Masters Theses

PURPOSE: The primary aim of this study was to examine the accuracy of a hip (Evenson algorithm) and wrist-worn (Crouter algorithm) accelerometer in assessing time spent in different intensity categories in pre-adolescent girls during semi-structured dance classes using direct observation (D.O.) as the criterion measure. The secondary aim of this study was to examine the validity of a wrist-worn accelerometer for dichotomizing pre-adolescent girls as meeting or not meeting different preselected doses of moderate-to-vigorous PA compared to the hip-worn accelerometer. METHODS: Data were collected and analyzed on a total of 6 participants (age = 10.22 ± 2.38) for the primary …

Alternative Methods For The Treatment Of Chemo-Resistant Cancers, Kaitlyn Wong

Doctoral Dissertations

Great strides have been made in cancer therapy in the past century, yet it remains one of the leading causes of death in the United States today. This work aimed to shed light on novel methods to treat a variety of aggressive and often chemo-resistant cancers both in vitro and in vivo. The first aim of this work was to evaluate the therapeutic efficacy of poly(methacryloyloxyethyl phosphorylcholine) (polyMPC) prodrugs compared to standard chemotherapeutic agents. Conjugation of polyMPC to drugs such as doxorubicin (Dox) can result in its improved solubility, prolonged half-life and therapeutic efficacy. PolyMPC and polyMPC-Dox (at a …

Macronutrients And The Risk Of Premenstrual Syndrome, Serena C. Houghton

Doctoral Dissertations

Premenstrual syndrome (PMS) affects 8-20% of reproductive-aged women, impacting work, family, and social interactions. Limitations in available PMS treatments, including side effects and limited medication efficacy, indicate the need for improved prevention. Modifiable risk factors for prevention of PMS include dietary factors. Several micronutrients have been identified as risk factors, but there has been little evaluation of macronutrients. Thus, the research aim was to examine prospectively whether macronutrient consumption was associated with PMS development among a subset of women enrolled in the Nurses’ Health Study II cohort. Chapter 1 evaluates the association of fat intake and PMS risk. Among 3,638 …

Feasibility Of A Combined Physical Activity And Sleep Education Intervention For Girls Living In A Low Socioeconomic Status Urban Community, Cory J. Greever

Doctoral Dissertations

Declining sleep duration and poor sleep quality is a public health epidemic disproportionately effecting elementary age girls living in low socioeconomic status urban communities. The Girls Dancing and Sleeping for Health (Girls DASH) program was designed to test the feasibility, acceptability, and efficacy of a combined physical activity and sleep education program in this population. In combination with baseline data from a previously conducted intervention in elementary age urban girls living in a low SES community in Springfield, MA, results from a cross-sectional analysis indicated that greater screen time was positively associated with parental reports of child’s sleep quality. Additionally, …

Transformative Learning Facilitated Dialogue: As A Tool For Social Change An Autoethnography, Leslie A. Saulsberry

Doctoral Dissertations

It is my goal, through this autoethnography, to take you through a reflective journey and present to you my personal theory of how facilitated dialogue in the context of transformative learning, critical reflection, systems thinking, shared vision, and holarchy can create a paradigm shift in our personal consciousness, decisions, behaviors, practice, and social policies—social change. My objective is to show how each theory is like a stepping-stone in the path towards social change. The purpose of this living work is to offer an alternative way of creating a healthy and whole society by exploring how facilitated dialogue can lead to …

Sleep Patterns, Urinary Levels Of Melatonin And Subsequent Weight Change In The Women’S Health Initiative Observational Study, Nicole M. Barron

Masters Theses

Results from prospective studies examining associations between sleep duration and weight gain have been mixed. Melatonin has been hypothesized to mediate the association between sleep duration and weight/body composition. In cross-sectional studies, aMT6s has been shown to be inversely associated with weight/body fat percentage. We examined associations between baseline sleep duration, insomnia status, aMT6s levels with weight/body fat percentage through 6 years, utilizing a subset 690 women who participated in a breast cancer case-control study nested within the WHI-OS. Multi-variable and mixed-effects regression was used to calculate beta-coefficients and 95% confidence intervals. Cross-sectional analyses showed urinary aMT6s levels were inversely …

One-Carbon Metabolism Related B-Vitamins Alter The Expression Of Micrornas And Target Genes Within The Wnt Signaling Pathway In Mouse Colonic Epithelium, Riccardo Racicot

Masters Theses

ABSTRACT

It has been widely recognized that microRNAs are involved in nearly all cellular processes that have been investigated and contribute to a variety of diseases including cancer. Our prior studies demonstrated the depletion of one-carbon metabolism related B-vitamins, including folate, vitamin B2, B6 and B12, induced a genomic DNA hypomethylation and an elevation of the tumorigenic Wnt signaling in mouse colonic epithelium. The present study aimed to define whether microRNAs serve as mediators between these B-vitamins and the Wnt signaling, and thereby influence intestinal tumorigenesis. MicroRNA expression profiles were measured using miRNA microarray and real-time PCR on colonic epithelial …

A Comparative Sustainability Study For Treatment Of Domestic Wastewater: Conventional Concrete And Steel Technology Vs. Vegetated Sand Beds (Vsb’S) And Their Relative Differences In Co2 Production, Alicia M. Milch

Masters Theses

Conventional wastewater treatment in the U.S. is an energy dependent and carbon dioxide emitting process. Typical mechanical systems consume copious amounts of energy, which is most commonly produced from fossil fuel combustion that results in the production of CO₂. The associated organic load is also metabolized by microorganisms into CO₂ and H₂O. As the desire to reduce CO₂ output becomes more prominent, it is logical to assess the costs of conventional treatment methods and to compare them to alternative, more sustainable technology. Vegetated Sand Bed (VSB) and Reed Bed (RB) systems are green technologies …

Antidepressant Use And Risk Of Colorectal Cancer In The Women's Health Initative, Jenna F. Kiridly

Masters Theses

Colorectal cancer is the third most common cancer among U.S. women; 63,610 new cases were estimated to have occurred in 2015. Prior studies found a reduced risk of colorectal cancer among antidepressant (AD) users, however, none adjusted for depression, which is itself linked to increased colorectal cancer risk and could confound this relationship. We assessed the relationship between ADs and AD drug classes with risk of colorectal cancer in a prospective cohort of 145,190 women between the ages of 50-79 without a previous history of cancer at enrollment. Current AD use was assessed at baseline. Over an average follow-up of …

Evaluating A Novel Photochemical Tool For Labeling And Tracking Live, Endogenous Calcium-Permeable Ampars, Rosamund Elizabeth Combs-Bachmann

Masters Theses

The purpose of this research is to advance development of a photochemical tool designed to probe the role of ionotropic glutamate receptor signaling in neurodegenerative processes, and to delve more deeply into the biological processes underlying the role of these receptors in signaling and memory formation. This ligand-targeted nanoprobe was designed and developed in our lab to label endogenous calcium-permeable AMPARs (CP-AMPARs) in live cells with minimal disruption to native receptor activity. Nanoprobe is designed to use naphthyl acetyl spermine (NASPM) as a photocleavable ligand to target and covalently label native CP-AMPARs with a non-perturbing, fluorescent marker that then allows …

The Adoption Of Harm Reduction By Abstinence Program Staff: A Qualitative Analysis, Morgan Coe

Masters Theses

Opioid overdose fatalities have quadrupled in the United States since the turn of the century, and are becoming increasingly recognized as a nationwide epidemic. While naloxone (narcan) has long been the standard treatment for overdose in clinical settings, it has not been issued to opioid users or their family members in the U.S. until relatively recently. As naloxone distribution and overdose training become more widespread, they are being incorporated into more and more abstinence-oriented settings including detoxes, halfway houses, and outpatient methadone and suboxone treatment programs. This qualitative study explored whether the staff at such programs found that training their …

Gait Changes During Exhaustive Running, Nathaniel I. Smith

Masters Theses

Runners adopt altered gait patterns as they fatigue which may increase energy expenditure and susceptibility to certain overuse injuries. Previous investigations have described changes in muscle performance and kinematic gait variables resulting from running fatigue. The purpose of this investigation was to characterize changes in joint moment patterns that develop as runners fatigue in order to better understand the kinetic bases for kinematic fatigue effects. It was hypothesized that when fatigued, runners would demonstrate increases in stance time, peak stance phase knee flexion angle, peak knee extension moment, peak swing phase hip flexion moment, and hip extension and plantarflexion angular …

Simulation Of 48-Hour Queue Dynamics For A Semi-Private Hospital Ward Considering Blocked Beds, Wei Chen

Masters Theses

This thesis study evaluates access to care at an internal medicine unit with solely semi-private rooms at Baystate Medical Center (BMC). Patients are divided into two types: Type I patient consumes one bed; Type II patient occupies two beds or an entire semi-private room as a private space for clinical reasons, resulting in one empty but unavailable (blocked) bed per Type II patient. Because little data is available on blocked beds and Type II patients, unit-level hospital bed planning studies that consider blocked beds have been lacking. This thesis study bridges that gap by building a single-stream and a two-stream …

Essays On Household Health Expenditures, National Health Insurance And Universal Access To Health Care In Ghana, Evelyn Kwakye

Doctoral Dissertations

Access to quality health services is essential for maintaining a healthy population and economic development hence the growing global consensus that universal health coverage is necessary. Ghana attempts to expand access by making basic health services free at the point of delivery through its National Health Insurance Scheme (NHIS). Prior studies indicate NHIS increases demand for health services, but questions remain about its impact on out of pocket payments, quality of services, and the financial viability of the program. Hence, this dissertation analyzes the financial risk in health care seeking, the effect of NHIS on out of pocket payments and …

Knowledge Development In Undergraduate Clinical Nursing Education, Nancy A. Craig-Williams

Doctoral Dissertations

ABSTRACT KNOWLEDGE DEVELOPMENT OF UNDERGRADUATE NURSING STUDENTS DOCTOR OF PHILOSOPHY FEBRUARY 2016 NANCY A. CRAIG-WILLIAMS B.S. ELMS COLLEGE, CHICOPEE, MA M.S. UNIVERSITY OF MASSACHUSETTS, AMHERST Ph. D. UNIVERSITY OF MASSACHUSETTS, AMHERST Directed by Genevieve Chandler ABSTRACT The changes in the healthcare environment, safety concerns of the practice setting and patient acuity has supported reform and research to identify areas for improvement (IOM, 2001, 2003). The Carnegie Foundation’s Educating Nurses, A Call for Radical Transformation (Benner, P., Sutphen, M., Leonard, V. & Day, L., 2010) explored the state of American nursing education. Among the findings are: patient safety issues, higher patient …

Motivations And Barriers For Saudi Nurses To Pursue A Doctoral Degree, Abdualrahman Alshehry

Doctoral Dissertations

Background/ Purpose: A shortage of Saudi PhD prepared nursing school faculty and a limited number of advanced degree programs in Saudi Arabia, are preventing the education of enough nurses to meet growing healthcare demands and the preparation of nurses for faculty roles. The purpose of this study was to identify motivating and barrier factors that may influence the decision of a nurse to seek further education at the doctorate level. Theoretical Framework: Cross’s (1981) Chain-of-Response Model was used as to guide this study and the interpretation of findings. Methods: A mixed method design was used for this study. A questionnaire …

Delays In Antiretroviral Therapy Initiation Among Hiv-Positive Individuals: Results Of The Positive Living With Hiv Study, Krishna C. Poudel, David R. Buchanan, Kalpana Poudel-Tandukar

Health Promotion and Policy Faculty Publication Series

Background: Lack of early initiation of antiretroviral therapy (ART) remains a major health concern due to increased risk of premature mortality and further HIV transmission. This study explored CD4+ cell count monitoring in relation to delays in ART initiation among HIV-positive individuals in the Kathmandu Valley, Nepal, where ART coverage was only 23.7% in 2011.

Design: We recruited a total of 87 ART-naïve, HIV-positive individuals aged 18 to 60 years through the networks of five non-government organizations working with HIV-positive individuals. We collected data on the history of ART initiation, CD4+ cell count monitoring, socio-demographic variables, perceived family …

The Emergence Of The Dose–Response Concept In Biology And Medicine, Edward J. Calabrese

Environmental Health Sciences Faculty Publication Series

A historical assessment of the origin of the dose–response in modern toxicology and its integration as a central concept in biology and medicine is presented. This article provides an overview of how the threshold, linear and biphasic (i.e., hormetic) dose–response models emerged in the late 19th and early 20th centuries and competed for acceptance and dominance. Particular attention is directed to the hormetic model for which a general description and evaluation is provided, including its historical basis, and how it was marginalized by the medical and pharmacology communities in the early decades of the 20th century.

Direct-Breastfeeding In The Neonatal Intensive Care Unit And Breastfeeding Duration For Premature Infants, Carrie-Ellen Briere, Jacqueline M. Mcgrath, Xiaomei Cong, Elizabeth Brownell, Regina Cusson

Elaine Marieb College of Nursing Faculty Publication Series

Aim

To explore the relationship between direct-breastfeeding in the neonatal intensive care unit (NICU) and breastfeeding duration after discharge.

Background

Initiating and maintaining breastmilk feeding is an important goal that begins in the NICU. Little is known about direct-breastfeeding in the NICU and its relation to breastfeeding duration.

Methods

Chart review of 46 infants (< 32 weeks gestational age or < 1500 grams) whose mothers provided breastmilk.

Results

One month after discharge, mothers still providing breastmilk were more likely to have provided ≥ 1 direct-breastfeed per day in the NICU (21.16, CI: 3.13–143.25, p < 0.01) and had prior breastfeeding experience (OR: 9.16, CI: 1.02–82.34, p < 0.05). At 4 months, mothers still providing breastmilk were more likely to have provided ≥ 1 direct-breastfeed per day in the NICU (OR: 12.80, CI: 1.39–118.32, p < 0.05).

Conclusions

Direct-breastfeeding in the NICU may play an essential role in preparing mothers for breastfeeding after …